Evaluating UK national guidance for screening of children for tuberculosis. A prospective multicenter study

Kampmann, B. et al. (2018) Evaluating UK national guidance for screening of children for tuberculosis. A prospective multicenter study. American Journal of Respiratory and Critical Care Medicine, 197(8), (doi: 10.1164/rccm.201707-1487OC) (PMID:29190430)

Abstract

Rationale and Objective: In order to identify infected contacts of tuberculosis (TB) cases, the UK National Institute for Health and Care Excellence (NICE) recommended the addition of interferon-gamma release assays (IGRA) to the tuberculin skin test (TST) in its 2006 TB guidelines. Treatment for TB infection was no longer recommended for children screened TST-positive but IGRA-negative. We carried out a cohort study to evaluate the risk of TB disease in this group. Methods: Children exposed to an infectious case of TB in their household were recruited from 11 paediatric TB clinics. TST and IGRA were carried out at baseline, IGRA repeated at 8 weeks and TST repeated if initially negative. Children were treated according to 2006 NICE guidelines and followed for 24 months. Measurements and Main Results: Of 431 recruited children 392 completed the study. We diagnosed 48 (12.2%) cases of prevalent TB disease, 105 (26.8%) with TB infection and 239 (60.9%) without TB infection or disease. 18 children aged two years and above had a positive TST but persistently negative IGRA. None received TB infection treatment and none developed TB disease. 90 (26.1%) children qualified for TB infection treatment according to 2006 NICE guidelines. In contrast, 147 (42.7%) children would have qualified under revised NICE guidance, issued in 2016. Conclusions: In this low prevalence setting we saw no incident cases of TB disease in children who were TST-positive but IGRA-negative and did not receive treatment for TB infection. Following the latest NICE guidance, significantly more children will require medication.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Paton, Dr James
• Authors: Kampmann, B., Seddon, J. A., Paton, J., Nademi, Z., Keane, D., Williams, B., Williams, A., Liebeschutz, S., Riddell, A., Bernatoniene, J., Patel, S., Martinez, N., McMaster, P., Basu-Roy, R., and Welch, S. B.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: American Journal of Respiratory and Critical Care Medicine
• Publisher: American Thoracic Society
• ISSN: 1073-449X
• ISSN (Online): 1535-4970
• Published Online: 30 November 2017
• Copyright Holders: Copyright © 2017 American Thoracic Society
• First Published: First published in American Journal of Respiratory and Critical Care Medicine 197:8
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher.